Modular reverse shoulder orthopaedic implant and method of implanting the same

ABSTRACT

A modular reverse shoulder orthopaedic implant includes a humeral stem component and a separable fracture epiphysis component having a number of suture holes formed therein. The fracture epiphysis component is configured to receive a number of sutures for surgically repairing a proximal humeral fracture.

This divisional application claims priority under 35 U.S.C. §121 to U.S.patent application Ser. No. 14/597,662, which was filed on Jan. 15, 2015and is expressly incorporated herein by reference.

TECHNICAL FIELD

The present disclosure relates generally to orthopaedic implants, andmore particularly to reverse shoulder orthopaedic implants.

BACKGROUND

During the lifetime of a patient, it may be necessary to perform a totalshoulder replacement procedure on the patient as a result of, forexample, disease or trauma. In a total shoulder replacement procedure, ahumeral prosthesis is used to replace the natural head of the patient'shumerus. The humeral prosthesis typically includes an elongated stemcomponent that is implanted into the intramedullary canal of thepatient's humerus and a hemispherically-shaped prosthetic head componentthat is secured to the stem component. In such a total shoulderreplacement procedure, the natural glenoid surface of the scapula isresurfaced or otherwise replaced with a glenoid component that providesa bearing surface upon which the prosthetic head component of thehumeral prosthesis articulates.

However, in some cases the patient's natural shoulder, including itssoft tissue, has degenerated to a severe degree of joint instability andpain. In many such cases, it may be necessary to change the mechanics ofthe shoulder. Reverse shoulder implants are used to do so. As its namesuggests, a reverse shoulder implant reverses the anatomy, or structure,of the healthy shoulder. In particular, a reverse shoulder implant isdesigned such that the prosthetic head (i.e., the “ball” in theball-and-socket joint) known as a glenosphere component is secured tothe patient's scapula, with the corresponding concave bearing (i.e., the“socket” in the ball-and-socket joint) known as a humeral cup beingsecured to the patient's humerus. Such a reverse configuration allowsthe patient's deltoid muscle, which is one of the larger and strongershoulder muscles, to raise the arm.

In some cases, the patient's natural shoulder anatomy has also sufferedtrauma such as a proximal humeral fracture. Proximal humeral fracturesare one of the most common fractures among elderly patients. In aproximal humeral fracture, the patient's humerus generally breaks into anumber of pieces including the humeral head, the greater tuberosity, thelessor tuberosity, and the humeral shaft.

SUMMARY

According to one aspect, a modular reverse shoulder orthopaedic implantincludes an elongated humeral stem component configured to be implantedinto the humerus of a patient. The implant also includes a fractureepiphysis component that is separable from the humeral stem component.The fracture epiphysis component includes a cup-shaped body having anannular rim formed in the superior end thereof. A lateral suture collarextends outwardly from the annular rim of the cup-shaped body within asegment of the annular rim defined by an anterior-most point of the rimand a posterior-most point of the rim. An anteromedial suture collarextends outwardly from the annular rim of the cup-shaped body within asegment of the annular rim defined by the anterior-most point of the rimand a medial-most point of the rim. An posteromedial suture collarextends outwardly from the annular rim of the cup-shaped body within asegment of the annular rim defined by the posterior-most point of therim and the medial-most point of the rim. The lateral suture collar, theanteromedial suture collar, and the posteromedial suture collar arediscontiguous with one another. The implant also includes a lockingscrew secured to the humeral stem component and the fracture epiphysiscomponent and a humeral cup component secured to the fracture epiphysiscomponent. The humeral cup component has a concave bearing surfaceconfigured to articulate with a rounded head surface of a glenospherecomponent.

Each of the lateral suture collar, the anteromedial suture collar, andthe posteromedial suture collar may be embodied with a number of sutureholes formed therein. In such a case, the suture holes may be positionedradially on the lateral suture collar, the anteromedial suture collar,and the posteromedial suture collar.

The lateral suture collar may be longer than both the anteromedialsuture collar and the posteromedial suture collar.

In an embodiment, the anteromedial suture collar and the posteromedialsuture collar are similar in size and face opposite one another alongthe annular rim of the cup-shaped body.

An outer surface of the cup-shaped body of the fracture epiphysiscomponent has a plurality of suture pockets formed in a posterior endthereof. Each of such suture pockets formed in the cup-shaped body ofthe fracture epiphysis component is separated by a wall, with each ofsuch walls having a suture hole formed therein.

The outer surface of the cup-shaped body of the fracture epiphysiscomponent may also have a number of suture holes extending therethrough,with each of such suture holes extending in the anteroposteriordirection.

According to another aspect, a modular reverse shoulder orthopaedicimplant includes an elongated humeral stem component configured to beimplanted into the humerus of a patient. The implant also includes afracture epiphysis component that is separable from the humeral stemcomponent. The fracture epiphysis component includes a cup-shaped bodyhaving a rounded outer surface, a channel formed in an inferior end ofthe rounded outer surface of the cup-shaped body, and a plurality ofwalls positioned in the channel so as to form a plurality of suturepockets within the channel. Each of the plurality of walls has a suturehole formed therein. The implant may also include a locking screwsecured to the humeral stem component and the fracture epiphysiscomponent and a humeral cup component secured to the fracture epiphysiscomponent. The humeral cup component has a concave bearing surfaceconfigured to articulate with a rounded head surface of a glenospherecomponent.

An outer surface of the cup-shaped body of the fracture epiphysiscomponent has an additional suture hole extending therethrough, withsuch an additional suture hole extending in the anteroposteriordirection.

The cup-shaped body of the fracture epiphysis component may include anannular rim formed in the superior end thereof with a number of suturecollars extending outwardly from the annular rim.

Each of such suture collars has a number of suture holes formed therein,with the suture holes being positioned radially on the suture collars.

The suture collars may include a lateral suture collar that extendsoutwardly from the annular rim of the cup-shaped body within a segmentof the annular rim defined by an anterior-most point of the rim and aposterior-most point of the rim. The suture collars may also include ananteromedial suture collar extending outwardly from the annular rim ofthe cup-shaped body within a segment of the annular rim defined by theanterior-most point of the rim and a medial-most point of the rim.Further, the suture collars may also include an posteromedial suturecollar extending outwardly from the annular rim of the cup-shaped bodywithin a segment of the annular rim defined by the posterior-most pointof the rim and the medial-most point of the rim. The lateral suturecollar, the anteromedial suture collar, and the posteromedial suturecollar are discontiguous with one another.

The lateral suture collar may be longer than both the anteromedialsuture collar and the posteromedial suture collar.

The anteromedial suture collar and the posteromedial suture collar maybe similar in size and face opposite one another along the annular rimof the cup-shaped body.

According to yet another aspect, a method of surgically repairing aproximal fracture of a patient's humerus includes rotating a lockingscrew to secure an elongated humeral stem component to a fractureepiphysis component and implanting the humeral stem component into theintramedullary canal of the patient's humerus. The method also includesadvancing a first suture through the humeral shaft of the patient'shumerus, through a first suture hole formed in an annular suture collarof the fracture epiphysis component, and through the patient's rotatorcuff proximate the greater tuberosity of the patient's humerus. A secondsuture is advanced through the humeral shaft of the patient's humerus,through a second suture hole formed in the annular suture collar of thefracture epiphysis component, and through the patient's rotator cuffproximate the lessor tuberosity of the patient's humerus. A third sutureis advanced through a third suture hole located in a suture pocket on anouter inferior surface of the of the fracture epiphysis component,through the greater tuberosity of the patient's humerus, and through thelessor tuberosity of the patient's humerus.

The method also includes tensioning the third suture so as to bring thegreater tuberosity of the patient's humerus and the lessor tuberosity ofthe patient's humerus into contact with one another, and thereaftertying the third suture so as to secure the greater tuberosity of thepatient's humerus and the lessor tuberosity of the patient's humerus incontact with one another.

The method also includes installing a polymeric humeral cup on thefracture epiphysis component subsequent to the tying step.

A tab formed in a superior surface of the humeral stem component may bepositioned into one of a plurality of notches formed in an inferiorsurface of the fracture epiphysis component so as to position thefracture epiphysis component in a selected version angle relative thehumeral stem component prior to rotation of the locking screw.

BRIEF DESCRIPTION OF THE DRAWINGS

The detailed description particularly refers to the following figures,in which:

FIG. 1 is a perspective view of a modular reverse shoulder orthopaedicimplant;

FIG. 2 is a superior elevational view of the fracture epiphysiscomponent and the locking screw of the modular reverse shoulderorthopaedic implant of FIG. 1;

FIG. 3 is a lateral elevational view of the fracture epiphysis componentof the modular reverse shoulder orthopaedic implant of FIG. 1;

FIG. 4 is an anterior elevational view of the fracture epiphysiscomponent of the modular reverse shoulder orthopaedic implant of FIG. 1;

FIG. 5 is an exploded perspective view of the modular reverse shoulderorthopaedic implant of FIG. 1 showing the locking tab and lockingnotches for adjusting the version angle of the fracture epiphysiscomponent relative to the humeral stem component; and

FIGS. 6-18 are perspective views showing the surgical technique forimplanting the modular reverse shoulder orthopaedic implant of FIG. 1into the humerus of a patient to surgically repair a proximal humeralfracture, note that the soft tissue (i.e., the rotator tendon) has beenremoved from FIGS. 17 and 18 for clarity of description.

DETAILED DESCRIPTION OF THE DRAWINGS

While the concepts of the present disclosure are susceptible to variousmodifications and alternative forms, specific exemplary embodimentsthereof have been shown by way of example in the drawings and willherein be described in detail. It should be understood, however, thatthere is no intent to limit the concepts of the present disclosure tothe particular forms disclosed, but on the contrary, the intention is tocover all modifications, equivalents, and alternatives falling withinthe spirit and scope of the invention.

Terms representing anatomical references, such as anterior, posterior,medial, lateral, superior, inferior, etcetera, may be used throughoutthis disclosure in reference to both the orthopaedic implants describedherein and a patient's natural anatomy. Such terms have well-understoodmeanings in both the study of anatomy and the field of orthopaedics. Useof such anatomical reference terms in the specification and claims isintended to be consistent with their well-understood meanings unlessnoted otherwise.

Referring now to FIGS. 1-5, there is shown a modular reverse shoulderorthopaedic implant 10 for replacing the natural shoulder joint of apatient subsequent to a proximal humeral fracture. The modular reverseshoulder orthopaedic implant 10 includes a rounded (e.g.,hemispherically-shaped) glenosphere component 12 that is secured to theglenoid surface of the patient's scapula by a metaglene component 14implanted in the bone tissue of the scapula. The glenosphere component12 articulates on the bearing surface 16 of a polymeric humeral cup 18of a modular humeral prosthesis 20. As can be seen in FIG. 1, themodular humeral prosthesis 20 includes a fracture epiphysis component 22and a humeral stem component 24. A locking screw 26 (see FIG. 2) locksthe fracture epiphysis component 22 to the humeral stem component 24 ina desired version angle (as described in more detail below). The humeralcup 18 is secured to the fracture epiphysis component 22 subsequent toimplantation of the modular humeral prosthesis 20 in the intramedullarycanal of a patient's humerus (see FIGS. 6-18).

As can be seen in FIG. 5, the superior end of the elongated humeral stemcomponent 24 has a bore 28 formed therein. A cannulated post 30 formedin the inferior end of the fracture epiphysis component 22 is receivedinto the stem component's bore 28. The sidewall defining the distal endof the stem component's bore 28 has a number of female threads definedtherein (not shown). The male threads of the locking screw 26 areadvanced through the cannulated post 30 of the fracture epiphysiscomponent 22 and into threading engagement with the female threadsformed in the humeral stem component 24 to lock the fracture epiphysiscomponent 22 and the humeral stem component 24 to one another.

As can be seen in FIG. 5, the superior end of the elongated humeral stemcomponent 24 also has a tab 32 formed therein. The tab 32 extendssuperiorly from the planar surface of the stem component's superior end.The planar surface of the inferior end of the fracture epiphysiscomponent 22 has a number of notches 34 defined therein. The notches 34are positioned radially relative to the central axis of the fractureepiphysis component's cannulated post 30. The surgeon may rotate thefracture epiphysis component 22 relative to the humeral stem component24 such that tab 32 is received into a selected one of the notches 34 toadjust the version angle of the fracture epiphysis component 22 relativeto the humeral stem component 24 prior to locking the two components toone another with the locking screw 26.

As can be seen in FIGS. 2-4, the fracture epiphysis component 22includes a cup-shaped body 36 having rounded outer surface 38. Thecomponent's body 36 has a hollow interior chamber 40 into which thehumeral cup 18 is locked. The bore of the cannulated post 30 opens intothe bottom of the interior chamber 40 to receive the head of the lockingscrew 26. The superior end of the component's body 36 defines an annularrim 42. The annular rim 42 defines the opening of the interior chamber40.

A number of suture collars 44, 46, 48 extend outwardly from the fractureepiphysis component's annular rim 42. Specifically, in the embodimentdescribed herein, a lateral suture collar 44 extends outwardly from alateral segment 54 of the annular rim 42, an anteromedial suture collar46 extends outwardly from an anteromedial segment 56 of the annular rim42, and a posteromedial suture collar 48 extends outwardly from aposteromedial segment 58 of the annular rim 42. As can be seen in FIG.2, the lateral suture collar 44 is longer than both the an anteromedialsuture collar 46 and the posteromedial suture collar 48, which are bothof similar size. Each of the suture collars 44, 46, 48 has a number ofsuture holes 50 formed therein. The suture holes 50 are positionedradially on the suture collars 44, 46, 48. As will be discussed below inmore detail, sutures may be passed through the suture holes 50 to securevarious features of the patient's humerus and surrounding soft tissue tothe fracture epiphysis component 22 and hence the modular reverseshoulder orthopaedic implant 10.

As can also be seen in FIG. 2, the suture collars 44, 46, 48 arediscontiguous with one another. In other words, the suture collars 44,46, 48 each include distinct end edges that are spaced apart from theend edges of the other suture collars 44, 46, 48. For example, the endedges 64 of the lateral suture collar 44 are spaced apart from therespective end edges 66, 68 of both the anteromedial suture collar 46and the posteromedial suture collar 48. Likewise, the respective endedges 66, 68 of both the anteromedial suture collar 46 and theposteromedial suture collar 48 are spaced apart from one another. Thisis shown geometrically in FIG. 2 in which the lateral suture collar 44is positioned within a segment of the annular rim 42 (i.e., the lateralsegment 54) defined by an anterior-most point 52 of the rim 42 and aposterior-most point 62 of the rim 42. The anteromedial suture collar 46is positioned within a segment of the annular rim 42 (i.e., theanteromedial segment 56) defined by the anterior-most point 52 of therim and a medial-most point 64 of the rim 42, with the posteromedialsuture collar 48 being positioned within a segment of the annular rim 42(i.e., the posteromedial segment 58) defined by the posterior-most point62 of the rim 42 and the medial-most point 64 of the rim 42 so as toface opposite the anteromedial suture collar 46.

It should be appreciated that such an arrangement in which the suturecollars 44, 46, 48 do not collectively extend all the way around theperimeter of the annular rim 42 may reduce the occurrences ofimpingement in some patients. In particular, depending on the anatomy ofa specific patient, the design of the fracture epiphysis component 22(i.e., it being devoid of a suture collar along its medial-most side)may reduce the occasions in which the medial side of the fractureepiphysis component would otherwise contact the scapula of the patientat certain ranges of motion. Such a configuration also facilitatesmating the fracture epiphysis component 22 with an insertion tool orextraction tool during implantation or removal of the modular reverseshoulder orthopaedic implant 10.

As can be seen in FIGS. 3 and 4, the inferior end of the lateral side ofthe rounded outer surface 38 of the fracture epiphysis component'scup-shaped body 36 has a channel 70 formed therein. A number of walls 72are formed in the body 36 at locations within the channel 70 therebyforming a number of suture pockets 74. Each of the walls 72 has a suturehole 76 formed therein. In a similar manner to the suture holes 50 ofthe suture collars suture collars 44, 46, 48, sutures may be passedthrough the suture holes 76 to secure various features of the patient'shumerus and surrounding soft tissue to the fracture epiphysis component22 and hence the modular reverse shoulder orthopaedic implant 10.

As can be seen in FIG. 4, one of the suture holes 76 (designated withreference numeral 78 in FIG. 4) is located on the medial side of thechannel 70 and extends in the anteroposterior direction. As will bediscussed below, this suture hole 78 allows for installation of an“around-the-world” or cerclage type suture.

The fracture epiphysis component 22 and the humeral stem component 24may be constructed with an implant-grade biocompatible metal, althoughother materials may also be used. Examples of such metals includecobalt, including cobalt alloys such as a cobalt chrome alloy, titanium,including titanium alloys such as a Ti6Al4V alloy, and stainless steel.Such metallic components 22, 24 may also be coated with a surfacetreatment, such as hyaluronic acid (HA), to enhance biocompatibility.Moreover, the surfaces of the fracture epiphysis component 22 and thehumeral stem component 24 that engage the natural bone, such as therounded outer surface 38 of the fracture epiphysis component 22 and theouter surfaces of the humeral stem component 24 may be textured tofacilitate securing the component to the bone. Such surfaces may also beporous coated to promote bone ingrowth for permanent fixation.

Moreover, each of the components of the modular reverse shoulderorthopaedic implant 10 may be provided in various differentconfigurations and sizes to provide the flexibility necessary to conformto varying anatomies from patient to patient. For example, the fractureepiphysis component 22 and the polymeric humeral cup 18 may be providedin various diameters to match the needs of a given patient. Moreover, asshown in phantom lines in FIG. 3, the fracture epiphysis component 22may be provided in different configurations in which the cannulated post30 is offset anteriorly or posteriorly (e.g., 2 mm) to provide eccentricright and left options. Further, for example, the humeral stem component24 may be provided in various lengths and diameters to match the needsof a given patient.

Referring now to FIGS. 6-18, there is shown a surgical procedure inwhich the modular reverse shoulder orthopaedic implant 10 is implantedin the humerus 80 of the patient to surgically repair a proximal humeralfracture. The surgical procedure begins with preoperative planning inwhich, amongst other things, a CT scan or other type of preoperativeimage may be obtained to plan placement, location, and orientation ofthe modular reverse shoulder orthopaedic implant 10. With thepreoperative planning complete, the patient's soft tissue is dissectedand retracted in order to allow access to the fractured shoulder joint.Full exposure of the patient's shoulder joint is typically achieved.

The surgeon then assembles the modular reverse shoulder orthopaedicimplant 10. Specifically, the surgeon selects a fracture epiphysiscomponent 22 and a humeral stem component 24 of the desired size andconfiguration and thereafter inserts the locking screw 26 through thecannulated post 30 of the epiphysis component 22. The version angle ofthe fracture epiphysis component 22 relative to the humeral stemcomponent 24 may be selected by inserting the tab 32 extendingsuperiorly from the planar surface of the stem component's superior endinto a selected one of the notches 34 formed in the inferior end of thefracture epiphysis component 22 (see FIG. 5). Thereafter, the surgeonmay use a hex driver or the like (not shown) to drive the locking screw26 thereby locking the fracture epiphysis component 22 and the humeralstem component 24 to one another. At this point in the surgicalprocedure, the surgeon may also assemble trial components that conformto the shape and size of the final implant for subsequent use in theprocedure.

Thereafter, as shown in FIG. 6, the patient's fractured humeral head issurgically removed and the greater tuberosity 82 and the lessortuberosity 84 are tagged. The surgeon then prepares the intramedullarycanal 86 of the patient's humerus 80 to receive the humeral stemcomponent 24 of the reverse shoulder orthopaedic implant 10. Initially,the surgeon uses a starter reamer of a relatively small diameter andthen sequentially reams with larger reamers to achieve the desiredaccess to the patient's intramedullary canal 86. The patient's reamedhumerus 80 is shown in FIG. 6.

As can be seen in FIG. 7, the surgeon then drills a pair of suture holes90, 92 through the posterolateral portion of the humeral shaft 88 at alocation approximately 2 cm below the fracture line. A pair of sutureholes 94, 96 are also drilled through the anterolateral portion of thehumeral shaft 88 at a location approximately 2 cm below the fractureline. The surgeon then places a strand of suture 102 through the suturehole 90 in an inside to out fashion and back through the suture hole 92thereby creating a loop outside the patient's humerus 80. As will bediscussed in more detail below, this suture 102 will be utilized tore-attach the greater tuberosity 82. This process is then repeated byplacing a suture 104 through suture hole 94 and suture hole 96. Thissuture 104 will be utilized to re-attach the lesser tuberosity 84.Another suture 106 is advanced through the suture hole 92 and the suturehole 94 thereby creating the same type of loop which will be utilized torepair the interval between the greater tuberosity 82 and lessertuberosity 84.

As shown in FIG. 8, an additional suture 108 is advanced through theanteroposterior suture hole 78. As will be discussed below, this suture108 will be utilized as an “around-the-world” suture. Either before orafter installation of the suture 108, the assembled and locked modularhumeral prosthesis 20 (i.e., the fracture epiphysis component and ahumeral stem component 24) is inserted into the intramedullary canal 86of the patient's humerus 80. A positioning jig (not shown) may be usedto clamp the modular reverse shoulder orthopaedic implant 10 to thehumerus 80 to set the height of the implant 10 if bone cement is used tofix the implant 10 within the intramedullary canal 86.

Thereafter, as shown in FIGS. 9 and 10, a hole 120 is drilled in each ofthe greater tuberosity 82 and the lesser tuberosity 84. As can be seenin FIG. 10, an additional suture 110 is positioned in the suture holes76 of the fracture epiphysis component's suture pockets 74. As discussedbelow, this suture 110 will be passed through the drilled holes 120 totie the tuberosities 82, 84 together with the modular reverse shoulderorthopaedic implant 10.

As shown in FIGS. 11 and 12, the surgeon then advances the posteriorlimb of the “around-the-world” suture 108 through the greater tuberosityrotator tendon 122 near the bone/tendon interface. The process isrepeated with the anterior limb of suture 108 being passed through thelesser tuberosity rotator tendon 124.

As shown in FIG. 12, one end of the suture 104 is advanced through oneof the suture holes 50 on the anterior side of the lateral suture collar44 with the other end of the suture 104 being advanced through one ofthe suture holes 50 of the anteromedial suture collar 46. Both ends ofthe suture 104 are then passed through the rotator tendon 124 near thetendon/lesser tuberosity interface. This process is repeated by passingone end of the suture 102 through one of the suture holes 50 on theposterior side of the lateral suture collar 44, the other end through asuture hole 50 on the posteromedial suture collar 48, and then passingboth ends through the greater tuberosity rotator tendon 122 near thebone/tendon interface. Likewise, as shown in FIG. 13, the ends of thesuture 106 are passed through separate suture holes 50 on the lateralside of the lateral suture collar 44. Thereafter, one end of the suture106 is passed through the greater tuberosity rotator tendon 122 near thebone/tendon interface, with the other end of the suture 106 being passedthrough the lesser tuberosity rotator tendon 124 near the bone/tendoninterface.

Referring now to FIG. 14, one end of the suture 110 (see also FIG. 10)is passed through the drilled hole 120 in the greater tuberosity 82,with the other end of the suture 110 being passed through the drilledhole 120 in the lessor tuberosity 84. The suture 110 is then tensionedand tied to bring the tuberosities 82, 84 together and secure them tothe modular reverse shoulder orthopaedic implant 10.

As shown in FIG. 15, the surgeon then advances the end of suture 104that passes through the drilled bone hole 96, the anteromedial suturecollar 46, and the lessor tuberosity rotator tendon 124 back down andunder the loop created between the drilled bone hole 94 and the drilledbone hole 96. The suture 104 is then tensioned upwardly thereby pullingthe loop up onto the lesser tuberosity 84 and creating a modified“figure 8”. The surgeon then ties and trims the excess suture 104.

The surgeon repeats the process, as shown in FIG. 16, by advancing theend of suture 102 that passes through the drilled bone hole 90, theposteromedial suture collar 48, and the greater tuberosity rotatortendon 122 back down and under the loop created between the drilled bonehole 90 and the drilled bone hole 92. The suture 102 is then tensionedupwardly thereby pulling the loop up onto the greater tuberosity 82 andcreating a modified “figure 8”. The surgeon then ties and trims theexcess suture 102.

As shown in FIGS. 17 and 18, the surgeon then passes the end of suture106 from drilled bone hole 92 down under the loop created betweendrilled bone hole 92 and drilled bone hole 94. The surgeon then tensionsthe suture 106 upwards thereby pulling the loop up onto the greatertuberosity 82 and creating a modified “figure 8”. The surgeon then tiesand trims the excess suture 106. Both ends of the “around-the-world”suture 108 are then tensioned, tied together around both tuberosities82, 84, and trimmed to provide additional stability to the fracturereduction.

The surgeon then completes the remaining surgical steps, such asinstallation of the humeral cup 18 and installation of the glenospherecomponent 12. The surgeon then closes the surgical site.

While the disclosure has been illustrated and described in detail in thedrawings and foregoing description, such an illustration and descriptionis to be considered as exemplary and not restrictive in character, itbeing understood that only illustrative embodiments have been shown anddescribed and that all changes and modifications that come within thespirit of the disclosure are desired to be protected.

There are a plurality of advantages of the present disclosure arisingfrom the various features of the apparatus, system, and method describedherein. It will be noted that alternative embodiments of the apparatus,system, and method of the present disclosure may not include all of thefeatures described yet still benefit from at least some of theadvantages of such features. Those of ordinary skill in the art mayreadily devise their own implementations of the apparatus, system, andmethod that incorporate one or more of the features of the presentinvention and fall within the spirit and scope of the present disclosureas defined by the appended claims.

1. A method of surgically repairing a proximal fracture of a patient'shumerus, the method comprising: rotating a locking screw to secure anelongated humeral stem component to a fracture epiphysis component,implanting the humeral stem component into the intramedullary canal ofthe patient's humerus, advancing a first suture through the humeralshaft of the patient's humerus, through a first suture hole formed in anannular suture collar of the fracture epiphysis component, and throughthe patient's rotator cuff proximate the greater tuberosity of thepatient's humerus, advancing a second suture through the humeral shaftof the patient's humerus, through a second suture hole formed in theannular suture collar of the fracture epiphysis component, and throughthe patient's rotator cuff proximate the lessor tuberosity of thepatient's humerus, and advancing a third suture through a third suturehole located in a suture pocket on an outer inferior surface of the ofthe fracture epiphysis component, through the greater tuberosity of thepatient's humerus, and through the lessor tuberosity of the patient'shumerus.
 2. The method of claim 1, further comprising: tensioning thethird suture so as to bring the greater tuberosity of the patient'shumerus and the lessor tuberosity of the patient's humerus into contactwith one another, and tying the third suture so as to secure the greatertuberosity of the patient's humerus and the lessor tuberosity of thepatient's humerus in contact with one another.
 3. The method of claim 2,further comprising installing a polymeric humeral cup on the fractureepiphysis component subsequent to the tying step.
 4. The method of claim1, further comprising positioning a tab formed in a superior surface ofthe humeral stem component into one of a plurality of notches formed inan inferior surface of the fracture epiphysis component so as toposition the fracture epiphysis component in a selected version anglerelative the humeral stem component prior to rotation of the lockingscrew.